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CRC Client Registration
PERSONAL INFORMATION
Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Address
*
Street Address
Suburb/Town
State
Post Code
Home Phone
*
I do not currently have an active home phone number
Mobile
*
I do not currently have an active mobile number
Email
*
I do not currently have an email address
BACKGROUND INFORMATION
Were you born in Australia?
*
Yes
No
Where were you born?
*
Do you identify as being of Aboriginal or Torres Strait Islander descent?
*
Yes
No
Is English your main spoken language?
*
Yes
No
What is your main spoke language?
*
Do you have access to transport?
*
Yes
No
Main method of transport
*
Own car
Public transport
Other
Please specify
*
Are you registered with a Jobactive provider?
*
Yes
No
Who is your Jobactive provider?
*
Do you have a disability or health issue that may restrict the type of work you can do?
*
Yes
No
Please specify any restrictions to work
*
What is your highest level of education
*
High School
Certificate I, II, III, IV
Diploma
University
Year level completed
*
Qualification/s completed
*
How did you hear about our services?
*
Internet
Facebook
Newspaper/TV
Family/Friend
TAFE Staff
Referred from another organisation
Other
Organisation referred from
*
Please specify
*
CAREER INFORMATION
Which best describes your current situation?
*
Unemployed
Studying
Employed
Length of unemployment
*
What course are you currently studying?
*
Are you employed
*
Full-time
Part-time
Casual
How many hours a week do you work on average?
*
I am seeking
*
Career guidance
To undertake training
Employment
I am seeking
*
Career guidance
Further training
Employment
I am seeking
*
Career guidance
To undertake training
Change careers
Greater employment
To reduce my work hours
Desired training
*
In your current job role?
*
Yes
No
Current job role
*
Desired industry/occupation (choose all that apply)
*
Accommodation & Food Services
Administrative & Support Services
Agriculture, Farming & Fishing
Education & Training
Electricity, Gas, Water & Waste Services
Finance & Insurance Services
Health Care & Social Assistance
Information Media & Technology
Manufacturing
Mining
Professional, Scientific & Technical Services
Public Administration & Safety
Rental, Hiring & Real Estate Services
Retail Trade
Transport, Postal & Warehousing
Career goals or any other relevant information
*
Any other relevant information
REGISTRATION INFORMATION
Please indicate if you have the following (choose all that apply)
Resume
Cover Letter
First Aid Certificate
Working With Children Check
White Card
Police Clearance
Drivers Licence
Licence Type
*
Personal barriers or challenges (choose all that apply)
Transport
Childcare
Disabilities
Accommodation
Financial
Work Clothes
Skills
Confidence
Other
Please specify
*
Career Goals & Actions
*
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Home Phone
Mobile
Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Home Phone
Mobile
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Home Phone
Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Mobile
Email
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Home Phone
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Mobile
Please note the Jobs & Skills Centre may contact you to participate in an outcome survey. My preferred method of contact is
Email
DECLARATION OF CONSENT
*
I give my consent to the Jobs & Skills Centre to discuss and share my information with relevant agencies and organisations to increase my opportunity to gain sustainable employment.
Location
*
Coorow CRC
Cue CRC
Dongara CRC
Gascoyne Junction CRC
Jurien Bay CRC
Leeman CRC
Meekatharra CRC
Mingenew CRC
Morawa CRC
Mullewa CRC
Perenjori CRC